Pericapsular nerve group block followed by regional anesthesia for pathological fracture fixation in a multiple myeloma patient

Abstract

Appropriate anesthetic technique for fracture fixation in multiple myeloma is crucial in minimizing perioperative complications. The use of pericapsular nerve group block followed by spinal anesthesia for the operative management of pathological fracture in multiple myeloma patient along with proper pre- and postanesthetic care ensures better outcome for the patient.

Abstract: Multiple myeloma is a malignant plasma cell disease that often presents with anemia, renal failure, hyperkalemia and osteolytic bone lesions. The advancements in drug therapy of multiple myeloma have prolonged the lifespan of the affected people, resulting in a rise in cases of surgical management of fractures in such patients. Anesthetic management, despite being of utmost importance in minimizing perioperative complications in such patients, has not been widely studied, especially in this part of the world. Hence, we report a case of 64 years diabetic, HbSAg positive male with hypothyroidism and a known case of multiple myeloma since the last 6 years, under medication for his comorbidities who suffered acetabular fracture. In this case report, the use of pericapsular nerve group block followed by spinal anesthesia for the operative management of the fracture has been discussed along with several pre- and postanesthetic considerations. With appropriate anesthetic techniques and proper pre- and postanesthetic care, better outcomes can be guaranteed.

Keywords: anesthetic complications; multiple myeloma; pericapsular nerve group block; regional anesthesia.

FIGURE 1

Nonenhanced computed tomography (NECT) of pelvis with 3D reconstruction.

FIGURE 2

Pericapsular nerve group (PENG) block. ASIS, anterior superior iliac spine; FA, femoral artery; FV, femoral vein; IPE, iliopubic eminence; PT, psoas tendon.